HEALTH CARE/Joan Retsinas

Universal Insurance: Protecting the 'Undeserving'

The Biblical admonition to be your brother's keeper is not hard.
Family ties are so strong that most people try to help their assorted
kin. (Look at the elected officials who tuck a moronic in-law or two
into civil service sinecures.) Fratricide a la Cain is both revolting
and rare. Similarly, "Love thy neighbor" doesn't ask much. Neighbors
tend to resemble each other, if only in socioeconomic status. More
importantly, we know our neighbors, so loving them &emdash; while
unlikely &emdash; is not implausible. "They" &emdash; whether kin or
neighbors &emdash; share ties with "us."

It is harder to care about strangers with different values,
different cultures. And it is even harder when we don't like those
strangers' cultures. That is why we give welfare so stingily,
insisting that recipients emulate the middle class values of
taxpayers: hard-working, ambitious, anchored in families. Our
"welfare-to-work" requirements demand that mindset. While taxpayers
willingly subsidize the "deserving" (of help) poor, taxpayers balk at
subsidizing the "undeserving" ones. (In a semantic twist, the people
undeserving of welfare are seen to deserve their penury.)

Under universal insurance, however, everyone &emdash; the lazy,
the unpatriotic, the criminal, the depraved &emdash; will come under
the protective governmental yoke. That is the rub with universal
insurance &emdash; one reason that politicians, running in a year of
deficits, run from this idea. One reason states are not expanding
their Children's Health Insurance plans, where the government insures
children whose parents earn too much for Medicaid, yet not enough to
buy insurance. One reason states are paring their Medicaid rolls. The
wider the net of government insurance, the more "unworthies" that net
will catch: people "we" wouldn't like if we knew them &emdash; people
whom we hope we never meet. Taxpayers will be subsidizing genuine
strangers.

So politicians draw a Jesuitical line through health insurance:
the "universal" idea is out. In this recessionary season, the
government must winnow out the unworthies. Children, especially young
ones, are in, but their parents &emdash; particularly the profligate
rarely-employed parents &emdash; are out. Certainly the parents who
could afford to buy insurance are out: They are "gaming" the system,
eager to save a buck. Indeed, some states have instituted premiums
for insurance, even though some parents - presumably the
irresponsible ones - won't pay. "Fiscally responsible" politicians,
wooing tax-weary voters, want to keep government insurance an
extension of welfare, with stringent eligibility.

But self-interest (a very middle-class value) should skew this
discussion. Compassion, generosity, justice &emdash; those virtues
may have little coinage in politics. Self-interest, though, does; and
in the name of self-interest, we should insert "universal" back into
the discussion. It is in the interest of fully-employed,
fully-insured taxpayers to cover everybody &emdash; not just
children, but their parents &emdash; giving Americans under age 65
the same protection that those over age 65 take for granted.

Here are reasons to insure (not love) the strangers &emdash; even
the unworthies &emdash; in our midst.

First self-interest reason: Infectious diseases. Hepatitis,
measles, rubella, tuberculosis, AIDS, and their ilk cross social
barriers. At work, at school, in movie theaters, in supermarkets, on
public transit, both the worthies and unworthies mingle, sometimes
sharing bodily fluids. Self-interest demands that everybody get
vaccinated and treated. While insurance coverage does not guarantee
treatment, it increases the odds.

Second self-interest reason: Productivity. A soaring Dow depends
upon productivity, which depends upon an industrious, creative
&emdash; and consequently healthy &emdash; workforce. Workers with
chronic diseases, like asthma, diabetes or arthritis, need regular
medical oversight. And healthy workers who get sick also need medical
attention, to return to work quickly. Again, insurance coverage won't
make workers take care of themselves; but it increases the odds.

Third self-interest reason: Money. The United States spends more
of its GDP on health care than countries with universal coverage, yet
we are buying not just MRIs and CAT scans, but marketers,
advertisers, utilization reviewers, and million-dollar CEOs. Today's
pastiche of plans, each with its administrative coterie, is expensive
&emdash; making Medicare, with its 3% administrative overhead (and
its government-salary CEO) a bargain. Universal coverage will cost
less than the status quo.

Ultimate self-interest reason: Us. "We" may someday be "them,"
vulnerable to a pink slip, an illness, a bankruptcy.

Ironically, the liberals pressing for universal coverage are not
fiscally rash. Instead, the politicians who press for
insurance-as-welfare are the profligate ones, because "Protecting
everybody" is not so much a Biblical injunction as an Adam Smith
one.

Joan Retsinas is a sociologist who writes about health care in
Providence, R.I.